Akter, T, Dawson, A & Sibbritt, D 2017, 'What impact does antenatal and postnatal care have on neonatal deaths in low- and lower-middle-income countries? Evidence from Bangladesh.', Health Care for Women International, vol. 38, no. 8, pp. 848-860.View/Download from: Publisher's site
We investigated the contribution of antenatal and postnatal care in reducing the risk of neonatal deaths in Bangladesh. The effects of these services were examined using adjusted Cox regression models and secondary data with 7,314 live-born infants. We observed that neonatal mortality was significantly decreased for newborns whose mothers' attended antenatal care services but postnatal care did not show any effect. Health promotion programs offering antenatal care in Bangladesh and other low- and lower-middle-income countries may build awareness about these practices. Further research is required to examine the reasons for the lack of impact of postnatal care on mortality.
OBJECTIVES: To examine the association of sociodemographic, antenatal and delivery care factors with the essential newborn care (ENC) practices of neonates born at home in Bangladesh. STUDY DESIGN: This study analyzed data of a cross-sectional survey-the Bangladesh Demographic and Health Survey, 2011. METHODS: This analysis considered 3190 most recent live-born infants who were delivered at home within three years of the survey. Logistic regression models were used to identify the factors affecting the implementation of six ENC practices, namely using disinfected instruments to cut the umbilical cord, avoidance of application of any substances to the umbilical cord stump, immediate drying and wrapping of newborns, delayed bathing of newborns, and immediate initiation of breastfeeding. RESULTS: Factors affecting ENC practices in Bangladesh are low parental education, low utilization of antenatal care services, the absence of skilled birth attendants, smaller size at birth, higher birth order and mother's age at birth. Regional factors also seem to considerably affect ENC practices. CONCLUSION: There is ample scope to improve the coverage of ENC practices in Bangladesh. Health promotion programmes that target parents with low education and older mothers may help to build awareness of ENC practices. This investigation provides insight into the key determinants of ENC practices, which require consideration when scaling up ENC practices in low-income and lower middle-income countries.
Akter, T, Dawson, A & Sibbritt, D 2016, 'What impact do essential newborn care practices have on neonatal mortality in low and lower-middle income countries? Evidence from Bangladesh.', Journal of Perinatology, vol. 36, pp. 225-230.View/Download from: Publisher's site
To assess the impact of essential newborn care (ENC) practices on the mortality of neonates delivered at home in Bangladesh.This study used cross-sectional data from the 2011 Bangladesh Demographic and Health Survey. Adjusted logistic regression model was used to examine the effect of ENC practices on neonatal mortality based on 3190 live-born infants.Delayed bathing (72 h after delivery) significantly contributed to reducing neonatal mortality. A significant but counterintuitive relation was observed between the dry cord care and neonatal deaths.Neonatal mortality may be reduced through emphasizing delayed bathing. Specific guidelines on the cleanliness of the fabric used to dry and wrap newborns, as well as emphasizing the use of clean delivery kits and initiation of immediate and exclusive breastfeeding, may improve neonatal outcomes. Further, the ENC guidelines in Bangladesh should include the application of topical antiseptics to the cord stump.Journal of Perinatology advance online publication, 3 December 2015; doi:10.1038/jp.2015.181.
Akter, T, Dawson, A & Sibbritt, D 2016, 'Workforce Interventions to Deliver Postnatal Care to Improve Neonatal Outcomes in Low- and Lower-Middle-Income Countries: A Narrative Synthesis', Asia-Pacific Journal of Public Health, vol. 28, no. 8, pp. 659-681.View/Download from: Publisher's site
Reducing neonatal mortality rates in low- and lower-middle-income countries (LMICs) requires
postnatal interventions to be delivered through an appropriately prepared and supported
workforce. This review examines health workforce interventions that deliver integrated packages
of postnatal care to improve neonatal outcomes in LMICs. We conducted a structured search
of peer-reviewed articles published during 2003-2014 that investigated the delivery of postnatal
interventions by formal and lay health workers. We selected 13 studies and analyzed them using a
narrative synthesis methodology. This review observed a wide divergence among studies regarding
the outcomes as well as the approaches and duration of workforce training and staff supervision.
Except 4, all studies observed a significant reduction in neonatal mortality. On the other hand,
teams of lay health workers appear to be more effective in improving neonatal outcomes. Further
improvement in the performance of health care providers may require emphasis on workforce
interventions such as competency assessment, the acquisition of appropriate skills, and supervisory
guidelines. Nevertheless, the heterogeneity and limited number of studies do not allow us to
arrive at definitive conclusions, and we recommend the need for the harmonization of future
studies, with uniformity of outcome measures and cost analyses.